Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

This week, Registered Dietitian Preethi Rahul explains how you can manage the vitamin D intake of breastfed infants and children.

Question:Is it true that breastfed babies need more vitamin D and can it be obtained through breast milk if the mother increases her vitamin D intake?

Answer:

Yes! Definitely breastfed babies need more vitamin D as human milk contains five metabolites of Vitamin D, providing 40-50 IU/ L of vitamin D activity. The need for additional vitamin D becomes progressively important with increasing age. Cow’s milk is usually fortified with 400 IU/L of vitamin D.

Vitamin D does not occur naturally in foods that humans normally eat. Moreover, the widespread use of sunscreens and public health recommendations to avoid sun exposure reduces dermal synthesis of vitamin D₃. Most people therefore get vitamin D₃ by taking a vitamin D supplement or by consuming vitamin D–fortified milk.

Vitamin D is undoubtedly important for fetal development and for bone development in childhood; it plays a much wider role in health and disease prevention. Vitamin D is essential for cell differentiation, the functional maintenance of membranes, as well as the functions of several organs including skin, muscle, pancreas, nerves, parathyroid gland and the immune system. It is important to understand that vitamin D is not really a vitamin; vitamin D₃ is a pre-pro hormone made in the skin in response to ultraviolet-B light exposure. Vitamin D3 is the precursor to form 25-hydroxyvitamin D₃ [25(OH)D₃], a pre hormone, which is ultimately converted to 1,25-dihydroxyvitamin D₃ [1,25(OH)₂D₃]. One of the most potent steroid hormones known, 1,25(OH)₂D has the capacity to affect many bodily functions beyond calcium metabolism.

All infant formulas sold in the United States must have a minimum vitamin D concentration of 40 IU/100 kcal (258 IU/L of a 20 kcal/oz formula) and a maximum vitamin D3 concentration of 100 IU/100 kcal (666 IU/L of a 20 kcal/oz formula).All formulas sold in the United States have at least 400 IU/L of vitamin D₃. Because most formula-fed infants ingest nearly 1 L or 1 qt of formula per day after the first month of life, they will achieve a vitamin D intake of 400 IU/day. Infants who receive a mixture of human milk and formula also should get a vitamin D supplement of 400 IU/day to ensure an adequate intake. As infants are weaned from breastfeeding and/or formula, intake of vitamin D–fortified milk should be encouraged to provide at least 400 IU/day of vitamin D.

Although vitamin D concentrations can be increased in milk of lactating women by using large vitamin D supplements, such high-dose supplementation studies in lactating women must be validated and demonstrated to be safe in larger, more representative populations of women across the world. Recommendations to universally supplement breastfeeding mothers with high dose vitamin D cannot be made at this time. Therefore, supplements given to the infant are necessary.

Check out the following articles related articles on vitamin D

Ask the Expert – Vitamin D Deficiency
40% of infants and toddlers have vitamin D deficiency – should you worry?
5 reasons to consider a multivitamin supplement

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Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

Ni Hao! Hope all of you are having a great week so far. This week is Food Allergy Awareness Week. This is the 12th year that the Food Allergy and Anaphylaxis Network (FAAN) has organized a week of awareness about food allergies. Check out their website for more details on how to get involved if you are interested. If your child has food allergies, I would love to have you leave a comment and share your tips for managing nutrition.

Here is another set of 5 nutrition related news and articles from this week that I found interesting. Feel free to share your opinions in the comments section.

Ready for your order? Now let me tell you about sodium in our special today…

When I am dining out, I am usually quite impressed by the ability of the server to rattle off details of their specials of the day. But did you ever wonder why they don’t tell you anything about salt as they try hard to make your mouth water by the fancy description of the recipe? Turns out that if they did, the shock value would be enough for you to simply say “no thank you” and walk out never to return again!

In their report “Heart Attack Entrees and Side Orders of Stroke“, researchers from the Center for Science in the Public Interest (CSPI) disclose that many of the popular menu items in chain restaurants have “dangerously high levels” of sodium. They examined 17 chain restaurants and found that 85 out of 102 meals had more sodium than a whole day’s worth (2300 mg) and several had more than 4 days worth of sodium! Among the top 10 saltiest meals -  Red Lobster’s Admiral Feast has over 7100 mg and Oliver Garden’s Tour of Italy lasagna with breadsicks, salad, dressing and a coke has over 6100 mg of sodium. Items on Kids menu are no better either with some containing as much as 2400 mg of sodium. CSPI estimates that reducing daily sodium intake by just 25% over the next 10 years could help save the US government over 9 billion dollars per year in direct medical costs.

Isn’t it ironical that even with so much salt in the meals, they still have the salt and pepper shakers on each table?

When eating out, ask for the low salt version of the dish you want to order. Same goes for fat, cholesterol and sugar. If enough customers start asking for healthy food, I think restaurants will change their menu to favor healthy recipes.

If Cheerios^® claims to lower cholesterol, should it be considered a “drug”?

The FDA certainly seems to think so. This week, they sent a warning letter to the CEO of General Mills informing him of “serious violations of the Federal Food, Drug and Cosmetic Act” by the promotion of Cheerios® Toasted Whole Grain Oat cereal as cholesterol lowering. That would qualify it to be a drug they reasoned, because it seems to treat a medical condition for which drugs are prescribed. In the eyes of the FDA, it counts as an unapproved use since the product has not been evaluated by the FDA for safety and efficacy. Drug approval takes very long and requires a very strict quality control in manufacturing. This could turn out to be quite serious for General Mills who may have to withdraw this claim or modify it to comply with the regulations.

Another claim that FDA found troublesome was that “heart-healthy diets rich in whole grain foods can reduce the risk of heart disease”. Seems like they conveniently forgot to include fruits and vegetables in this claim, which together with a diet low in fat and cholesterol lower the risk of heart disease. Whole grains or dietary fiber is only one factor.

We personally like Cheerios -  it is a brand I have written about favorably in the past. But I am glad that FDA is sensitive to such over-ambitious claims cited in their warning letter. It is not uncommon to see health-related claims on products – for example, nutritional supplements make all kind of claims – but then they are also required to add that their claims have not been evaluated (and approved) by the FDA.

Will this affect your decision to by Cheerios or other products from General Mills? Weigh in.

HIV and safety of breast milk

Imagine the heartbreaking dilemma of a woman with HIV wanting to feed her baby with breast milk. Now imagine that this woman lives in a poor country, where women like her are routinely told not to breastfeed and formula is not affordable.  What are her options? Should she let her baby grow up without the benefit of breast milk, or in the worst case, even die of early childhood diseases?

It  is a sensitive topic; something a lot of us are fortunate enough not to have to worry about. Yet, the problem cannot be ignored if we want all children to grow up healthy. I was pleased to read about the efforts of researcher Sera Young of UC Davis, who is helping women of Tanzania learn a protocol to pasteurize breast milk by flash heating without affecting its nutritional value. Even though the WHO recommends HIV-positive to pasteurize breast milk,  no one in those countries knows how to do it. This project is a great start in that regard. And it is encouraging to note that the acceptance level is very high. The challenge will be to ensure that the pasteurization protocol is properly followed so that the breast milk is safe and still maintains its nutritional value. It is one thing to do it under the watchful eyes of a researcher, and something else to do it everyday on your own. But I do hope that it works in future at a much larger scale.

Link between obesity and food allergy?

This is what you could call a double whammy! Not only do we have rising rates of childhood obesity, we also have an increase in the number of early childhood food allergies and sensitivity to various foods. Now researchers from the University of North Carolina, Chapel Hill, have uncovered a link between obesity and high levels of IgE (antibody associated with an allergic response) based on the 2005 – 2006 NHANES data. Although, they are careful not to draw too many conclusions, it hasn’t taken all that long for people to ask the question “Is obesity fueling food allergies“? It is hard to say if high BMI and obesity is a cause of food allergy, or simply a common feature. Also, is there even a common cause between the two? Hard to say – because even though poor nutrition is linked to high BMI, we cannot say for sure that it also causes food allergy or intolerance. Could it be that the child’s parents have allergies? Could it be that they introduced these foods too early when the child’s digestive system was not fully developed? Just by looking at the survey data and drawing conclusions based on a statistical analysis does not mean that obese children are more likely to develop food allergies.

Support Share Our Strength’s Great American Bake Sale

If you love to bake and would like do some good at the same time, you have a great opportunity to help end childhood hunger. Can you believe that 500,000 more children live in poverty now compared to an year ago and 16 million children rely on food stamps? Personally, I find this statistic embarrassing in our land of plenty! Now, Share Our Strength is running their Great American Bake Sale campaign where you can get involved – the proceeds of your bake sale will go to fund after-school and summer feeding programs in your community and across the country.

You can also support them by blogging about it, or even contributing a recipe to their virtual bake sale! They will raise money by selling eBooks of recipes.

The only thing I will add is that even though this campaign is sponsored by Domino and C&H sugar, try to go low on sugar! Leave a comment if you decide to contribute.

Enjoy your weekend!

Photo source – Davichi on Flickr
©2009 Littlestomaks.com